Provider Demographics
NPI:1437817376
Name:COTTRILL, CARSON ANDREW
Entity Type:Individual
Prefix:
First Name:CARSON
Middle Name:ANDREW
Last Name:COTTRILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LUMBERPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26386
Mailing Address - Country:US
Mailing Address - Phone:681-205-4170
Mailing Address - Fax:
Practice Address - Street 1:116 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LUMBERPORT
Practice Address - State:WV
Practice Address - Zip Code:26386
Practice Address - Country:US
Practice Address - Phone:681-205-4170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant